Project Summary/Abstract Young adults with cancer experience more emotional distress and greater impairments in health-related quality of life (HRQOL) than older patients. Cancer diagnosis during young adulthood interferes with participation in normal developmental tasks such as obtaining higher education, starting a career, establishing financial independence, and developing romantic partnerships. This disruption in normal activities coupled with the unfamiliar and challenging demands of cancer treatment results in emotional distress and reduced HRQOL. There is an urgent and critical need to develop, test, and implement evidence-based interventions to support these young adults as they navigate perhaps the most challenging and debilitating period of their lives. Current psychosocial care does not adequately address the unique concerns of young adults. An optimal solution would give young adults the skills to deal with diverse and numerous stressors, address underdeveloped problem-solving ability characteristic of this age group, and be relatively simple to learn and use during the highly stressful time following a diagnosis of cancer. To address these clinical care gaps, this project will evaluate the efficacy of a problem-solving skills training intervention developed specifically for young adults and grounded in the core tenets of problem-solving therapy. ?Bright IDEAS-Young Adults? (Bright IDEAS-YA) draws upon and notably extends prior research demonstrating the efficacy of a cognitive-behavioral problem-solving skills training program for reducing emotional distress in caregivers of pediatric patients. Bright IDEAS-YA is a 6-session, one- on-one face-to-face intervention that teaches patients a systematic approach to overcome personal challenges across any life domain. It aims to enhance patients? problem-solving ability in the face of significant stressors such as cancer. In preliminary work, young adults with cancer found Bright IDEAS-YA acceptable, relevant, and useful. Patients who received Bright IDEAS-YA showed improvements in problem-solving ability and reductions in symptoms of depression and anxiety. In the proposed project, we will conduct a multi-site randomized controlled trial of Bright IDEAS-YA compared with enhanced usual psychosocial care with 300 YA patients (ages 18-39 years) undergoing cancer treatment. We will evaluate efficacy and examine mediators and moderators of intervention effects using assessments at baseline, post-intervention (3 months), and follow-up (6 and 12 months). We hypothesize that young adults who receive Bright IDEAS-YA will report improved problem-solving skills, lower distress (i.e., depression and anxiety), and better HRQOL compared with enhanced usual psychosocial care. The proposed study aligns with the National Cancer Institute?s Division of Cancer Control and Population Sciences mission to reduce the burden of cancer and enhance the quality of life of patients and survivors, particularly among vulnerable groups such as young adults.